Provider Demographics
NPI:1780647859
Name:LISA ESTELLE PSYD
Entity Type:Organization
Organization Name:LISA ESTELLE PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:509-467-9111
Mailing Address - Street 1:12605 N FAIRWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208
Mailing Address - Country:US
Mailing Address - Phone:509-467-9111
Mailing Address - Fax:509-468-1294
Practice Address - Street 1:8606 N WALL
Practice Address - Street 2:STE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:509-467-9111
Practice Address - Fax:509-468-1294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty